Healthcare Provider Details

I. General information

NPI: 1336209303
Provider Name (Legal Business Name): SYCAMORE ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N 7TH ST
TERRE HAUTE IN
47807-1005
US

IV. Provider business mailing address

PO BOX 3036
INDIANAPOLIS IN
46206-3036
US

V. Phone/Fax

Practice location:
  • Phone: 812-231-4608
  • Fax: 812-231-4675
Mailing address:
  • Phone: 812-231-4608
  • Fax: 812-231-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS M PENDERGAST
Title or Position: OWNER
Credential: M.D.
Phone: 812-231-4608